Articles Plantar Fasciitis

November 5, 2019

This article covers basic anatomy, what plantar fasciitis is, symptoms, causes, risk factors, diagnosis, medical and physiotherapy management.

Basic Anatomy

Your foot is a highly complex structure specifically designed for locomotion and weight bearing. The bones of the mid foot are arranged in such a way where arches are formed to help:

  • distribute weight evenly
  • absorb shock 
  • propel your forwards as you walk/run
3 Arches of the Foot

What is the Plantar Fascia?


The plantar fascia is a thick band of tough fibrous tissue located on the sole of your foot. It attaches to the underside of your heel bone and extends towards the base of your toes. This structure assists the muscles, bones and ligaments to support the arches of the foot.

What is Plantar Fasciitis?

Micro tears and inflammation of the plantar fascia can give rise to this condition. This usually occurs where the plantar fascia attaches to the heel bone. 


This is most commonly observed in people between the ages of 40-60 years. Unfortunately, an inability to adequately rest the foot will further aggravate the condition and result in prolonged recovery times (i.e. several months). In chronic cases, prolonged inflammation can result in calcification and formation of a heel spur. 

Foot X-Ray, Heel Spur

Causes

 This condition can arise from:

  • Overuse (i.e. prolonged standing, excessive walking/running)
  • Over stretching of the plantar fascia (i.e. flat medial foot arches) 
  • Sudden impact (i.e. landing heavily on your heel)

What are the Symptoms of Plantar Fasciitis?

  • Pain along the medial arch/underside of heel bone
  • Severe pain with the first few steps following a long period of rest (i.e. first thing in the morning) 
  • Aggravation of symptoms with prolonged standing, walking or running
  • Aggravation of symptoms when weight bearing barefoot
  • Aggravation of symptoms when weight bearing on hard surfaces (i.e. wooden floors)
Common areas of pain

Risk/Contributing Factors

  • Excessively high or low medial arches
  • Being overweight or sudden weight gain (i.e. pregnancy)
  • Occupations involving prolonged standing 
  • Participating in running sports
  • Inadequate footwear
  • Excessively tight lower  leg muscles
  • Stiff ankle joints 
  • Diabetes 
Plantar fasciitis is often seen in running populations

Diagnosis

Diagnosing this condition is mainly based on an individual’s clinical presentation through a thorough subjective and physical examination. An xray, ultrasound or MRI may also be required to exclude/identify other injuries.   

Physical foot Examination

   
Management 

  • Most cases will recovery with conservative physiotherapy treatment (see below)
  • Anti inflammatory medications (i.e. Nurofen)
  • More persistent cases may benefit from a cortisone injection into the plantar fascia
  • Surgery is rare and only indicated in severe long standing cases where conservative treatment has failed
Calf Stretch

Physiotherapy Management 

  • Reduce inflammation and decrease pain. Modalities such as RICE (Rest, Ice, Compression, Elevation), taping and manual therapy may be used 
Manual therapy to increase ankle joint stiffness
  • Provide education, identify and modify aggravating factors
“Pushing through the pain” is likely to further aggravate this condition and prolong recovery
  • Exercises to stretch out the affected muscles and increase ankle joint movement
Kneeling plantar fascia stretch
  • Strengthening your core, hip and leg muscles to improve your lower limb posture
Resistance band exercises
  • Correction of foot wear (i.e. orthotics)
Orthotics support the medial arch and can take pressure of the plantar fascia
  • Prescription of night splints 
Stressberg sock

Please keep in mind the information provided is general in nature and should not be used as a substitute to consult your treating health professional. If you have any specific questions or require assistance with your individual treatment requirements please do not hesitate to contact My Family Physio in Pittwater Place Shopping Centre.

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